I have been following recent correspondence regarding downgrading of hospitals with interest.

Fit for the Future presents a radical reform of the NHS. Some aspects of it seem good, such as localised health care and specialisation of units where possible.

On the other hand, critics such as Keep the NHS Public fear that they are really a smoke-screen for cutting services and there are fears that "specialisation" can fragment the NHS and lead to creeping privatisation.

Whatever your views there is no getting away from the fact that no one is happy at the prospect of closures to accident and emergency departments - after all who, when faced with an emergency, will be thinking about which type of unit they should go to? Most people will want to get to their nearest A&E department as soon as possible.

We have been told that due to the higher level of specialisation the reforms offer that lives will be saved. There is also acceptance that for other cases such as heart problems, strokes and accidents, the longer travelling time could lead to loss of life as chances of survival are higher if treatment is received in the first hour.

The problem is that the evidence base for the radical changes Fit for the Future offers is not sufficient for us to know if more or fewer lives will be lost.

When Fit for the Future was presented to Brighton and Hove City Council, Green councillors tabled an amendment saying downgrading any of the three hospitals was not acceptable. It called for the primary care trust to come up with options which would do justice to the expectations and requirements for health provision that people expect and deserve from the NHS.

It was disappointing that Brighton and Hove's Conservative and Labour councillors tabled a joint amendment, drafted less than 24 hours before the meeting, which would protect only Haywards Heath and Worthing A&E departments and leave Chichester vulnerable.

It seems that we are now suffering the consequences of the reforms. Only time will tell if they are delivering better overall care but perhaps by then the NHS will have become so fragmented that it will be difficult to tell.